Objective To evaluate the therapeutic efficacy of endoscopic total thyroidectomy performed via a combined transoral and submental approach in patients with thyroid cancer Methods This study enrolled 227 patients diagnosed with papillary thyroid carcinoma （PTC） who underwent total thyroidectomy combined with unilateral central lymph node dissection at the Department of Thyroid and Hernia Surgery， the First Affiliated Hospital of Gannan Medical University， between October 2019 and March 2024. Of these patients， 68 were treated using the fully endoscopic combined transoral and submental approach （endoscopic group）， whereas 159 underwent the conventional open anterior cervical approach （open group）. A retrospective analysis was performed to evaluate and compare the therapeutic outcomes between the two groups. Results Surgical procedures were successfully completed in both groups without complications， and no additional incisions were required in the endoscopic group. Compared with the open surgery group， the endoscopic group had a longer operative duration， reduced intraoperative blood loss， and greater total postoperative drainage volume. Furthermore， on the first postoperative day， patients in the endoscopic surgery group exhibited lower levels of serum calcium and intact parathyroid hormone （iPTH）. The incidence of temporary parathyroid dysfunction was significantly higher in the endoscopic group （51.47%） than in the open surgery group （30.82%）， and this difference was statistically significant （P < 0.05）. No significant differences were found between the two groups regarding preoperative serum iPTH levels， preoperative serum calcium levels， number of dissected lymph nodes， incidence of temporary recurrent laryngeal nerve injury， postoperative hemorrhage， incision infection， or submental sensory loss （P > 0.05）. Conclusions Compared with traditional open surgery， total thyroidectomy via TOETSMVA under full endoscopy demonstrates comparable efficacy and favorable long-term safety. However， it is associated with a higher risk of transient hypoparathyroidism in the short term， highlighting the necessity for enhanced intraoperative protection of the parathyroid glands.